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1、经脐入路腹腔镜胆囊切除术40例临床分析肖怀文朱江帆吴鸣龚建民孔祥东[摘要]目的：探讨经脐入路内镜手术(TransumbilicalendoscopicsurgeryTUES)用于胆囊切除术的安全性、可行性及手术特点。方法：回顾分析2010年〜2012年作者收治的40例TUES胆囊切除术患者的临床资料：均采用脐下20mm切口，造气腹后穿刺入3只穿刺鞘(Trocar),屮间10mm,两边各插入一只5mm,术中使用10mm镜管，曲线型抓钳、电勾，超声刀及5mmHemolock施夹器等。结果：40例均获得成功，无中转或增加穿刺孔；手术时间(
2、65.75±24.80)min；术中出血(29.13±19.84)ml；不放置引流,无术后并发症发生。随访3月〜3年，无术后胆漏、迟发性胆•漏，黄疸，切口感染等发生，腹壁无可见瘢痕。结论：手术操作要求较高，但超声刀及曲线型抓钳的使用使TUES胆發切除术安全可行，术后腹壁无瘢痕,美观，值得推广。[关键词]经脐手术腹腔镜胆囊切除术无瘢痕TransumbilicalEndoscopicSurgeryinLaparoscopicCholecystectomy:Reportof40CasesXIAOHuai-wen，ZHUJiang-fan*
3、,WUMing,GONGJian-ming,KONGXiang-dong*DongfangHospital,TongJiUnivercity.Shanghai,200120,China[Abstract]Objective:Toinvestigatethesafety,clinicalcharacteristicsandfeasibilityoflaparoscopiccholecystectomythroughTUES.Methods:From2010to2012,theclinicaldataof40patientswhohav
4、eunderwenttransunbilicalendoscopiclaparoscopiccholecystectomythroughthreeTrocarsplacedaroundumbilicuswithonlyoneincisionwereretrospectivelyanalyzedatourhospital;Allusebelowhilumand20mmincision,madeafterpneumoperitoneumPiercethroughthreepuncturesheath(Trocar),intermedia
5、te10mm,bothsideseachinserta5mm,intraoperativeuse10mmlenstube,curvetypegrabforceps,electricityhook,ultrasonicknifeand5mmhemolockdevice,etc.Results:Allcasesweresuccessfully,notransfereneeoraddingthepuncturehole;Theoperationtimeis(65.75±24.80)min;Theintraoperativebleeding
6、is(29.13±19.84)ml;Therearenodrainageandpostoperativecomplications・On3monthsto3yearsfollowing-up,nopostoperativebileleakage,late-occurredbileleakage,jaundice,incisioninfectionoccursandnovisiblescarwerefoundontheabdominalwall.Conclusions:Theoperationdemandingishigh,butth
7、euseofultrasonicknifeandcurvetypegrabclamptoTUEScholecystectomy,itissafeandfeasible.Andthepostoperativeabdominalwallhasnovisiblescar,looksbeaut讦ul,whichisworthytobepopularized・[KeyWords]TUES；LaparoscopicCholecystectomy；NoScar随着腹腔镜胆囊切除术(LaparoscopicCholecystectomyLC)技术的
8、不断完善和发展，及新型器械的不断涌现，普外科微创手术不断被引向深入。2007年5刀，朱江帆教授首先提出了经脐入路手术(TransumbilicalendoscopicsurgeryTUES)的概念,并相继于同年9月完成动物实验及临床运
